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The work 'The Professor Who Couldn't Write' summarizes the complicated diagnosis of a professor with a rare infective endocarditis who underwent successful surgery.
The Cardiology resident of the Servet, Javier Jimeno Sánchez, has won the Best clinical case of the League 2019, a competition sponsored by the Spanish Society of Cardiology at the national level, for the clinical case 'The professor who could not write', a title that summarizes the complicated process of a patient who suffered a rare and very complex infective endocarditis and whose suspected diagnosis and team treatment of the disease allowed a happy ending.
The teacher, middle-aged, tired for days and with a fever, came to the emergency room because he couldn't write on the blackboard. He was unable to move his arm properly. A cranial scan showed that he had brain damage, but what had caused this problem that prevented him from writing, how had this damage developed in the cerebellum. The specialists raised numerous questions and carried out various tests in search of answers, but it was not easy. No germ was identified in the samples collected and the neurological damage required caution.
A very illustrative case
"In our opinion, it is a very illustrative case that requires significant diagnostic suspicion, with an unusual etiology of endocarditis and very striking radiological study images," explains Javier Jimeno Sánchez. Dr. Jimeno was a second-year resident when this case arrived at the Servet Emergency Room. He accompanied the cardiologist Ángela Juez and they followed all the clues until they found the correct diagnosis.
"Initially we couldn't know what was happening but "you pull the rope", you link everything together and in the end we conclude with the diagnosis of endocarditis, an infection at the level of the heart valve, finally identifying a microorganism from the HACEK group as the causal agent," he recalls. . "But it is a diagnosis that is achieved within days, when you have the results of all the tests, the ultrasound, the blood cultures and in collaboration with other services," he explains.
The professor required antibiotic and surgical treatment. And the resident helped collect all the information, analyze it, draw conclusions, write it up, present it and... he won the case. Jimeno draws various learning conclusions from this experience, although two stand out: time management and the need, as the clinical practice guidelines insist, to have multidisciplinary teams, what cardiologists call the endocarditis team.
The care for this patient started from Primary Care and in the Hospital required the involvement of nine services: Cardiology, which carried the greatest weight, Cardiac Surgery, Neurology, Microbiology, Ophthalmology, Radiology, Infectious Diseases Unit, Emergencies and Maxillofacial Surgery. The latter extracted the tooth suspected of being the source of the infection that attacked the heart valve.
